Motivational Interviewing

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Motivational Interviewing

R: Resist The Righting Urge

• This reflex begins with our desire to help others – so it makes sense, BUT…

• While our tendency as practitioners is to try to actively fix problems for our clients’ lives – this actually reduces the likelihood of client change.

• Clients we are working with may not view change as necessary or possible. • There may be costs associated with change (such as? fear and uncertainty, changes to

relationships, monetary and time demands) which argue for maintaining the status quo and influence client to stay with the current behavior.

U: Understand Your Client’s Motivation

See ‘costs associated with change’

MI takes position that motivation comes from within the client – We will assist clients in finding motivation that lies within and help them recognize it.

Direct toward discrepancies that exist between what they want and how their behavior impacts these goals.

L: Listen To Your Client

Create atmosphere where clients can safely explore conflicts and face difficult realities. E: Empower Your Client

Support belief that clients are capable, have ideas for solutions, and can enact changes if they decide to do so. Clients are the experts of their lives.

Many of the L2C clients you’ll be serving have tried to change their behavior – in one way or another – prior to enrolling in this program.

As such, one of the factors we can expect in our clients is a certain amount of demoralization about their lack of success.

So be hopeful about the possibility of change for them – they were successfully accessing medical care at one point. What was working then?

Sometimes clients will need to ‘borrow’ hopefulness from you. Talking about other clients’ successes can be helpful.

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Exercise: Rating Samples for MI Spirit Here are examples of short client statements and practitioner responses. Review the exchange and then decide if the practitioner’s response is consistent with the spirit of MI (thumbs up) or not (thumbs down). 1. Sarah’s husband Richard: I’m just furious that she lied to me and had this affair behind my

back. I can’t believe I didn’t see it. I feel like such an idiot. Practitioner: In retrospect, what signs did you overlook? Thumbs up ___________ Thumbs down_____x_________ Why? Practitioner missed chance to express empathy and instead slipped into information gathering.

2. Arthur: I know my dad told you I’m depressed, but I’m not. Just because I don’t want to play football doesn’t mean I’m depressed. Practitioner: Your father is worrying needlessly. What do you think he’s seeing that makes him worry this way? Thumbs up _____x______ Thumbs down_______________ Why? Practitioner attends to the relationship issues first and asks an open-ended question that encourages exploration.

3. Tanya: I need to come up with some sort of plan to help me get back on track now. This health crisis has thrown me for a loop. I can’t think about anything else. What do you think I should do? Practitioner: Well, I have some ideas about what might help, but first let me hear what you’ve already considered. Thumbs up ______x_____ Thumbs down_______________ Why? Practitioner avoids expert role and makes active attempt to seek collaboration from client. Does not dodge client’s request for advice, but looks to client as expert.

4. Arthur: I’m not going to keep that stupid thought journal. How does it help me to monitor my “loser” thinking? I’m working with you to feel better, and paying attention to all that makes me feel worse. Practitioner: Okay, Arthur, you might be right. This works for many folks, but not everyone. Maybe we need to try a different way to approach this. We’ve talked about other ways to address this issue. What makes sense to you to practice instead? Thumbs up _____x______ Thumbs down_______________ Why? Practitioner avoids power struggle and looks for ways to collaborate.

5. Brittany: My doctor gave me a long list of all the things I have to do to manage my care. It’s overwhelming. I have to take medication three times a day. I can’t even remember to feed my dog every single day. I just can’t do it. But I’m afraid I’ll die if I don’t. Practitioner: You can do this. You have to. Thumbs up ___________ Thumbs down______x_________ Why? Comfort and encouragement are important interventions, but in this case, it violates the client’s autonomy by suggesting she has no choice and fails to recognize that the client’s dilemma itself provides the momentum needed for change.

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Exercise: Hypothesis Testing and the Formation of Reflections For the following statements, generate at least 3 alternate hypotheses for each client statement below. Example: I am an organized person. You mean that…you like to have things orderly. You mean that…you tend to rely on routines. You mean that…you don’t like when things change unexpectedly. You mean that…your desk is neat. You mean that…you think logically. *Note that several of these hypotheses go well beyond what organized might mean. Some may be wrong, though all acknowledge some component of what could be considered organized. I don’t like conflict. You mean that….it makes you uncomfortable when people disagree. You mean that…you work hard to resolve differences. You mean that…you avoid confrontations. You mean that…you look for ways to work together. You mean that…anger scares you. I let things bother me more than I should. You mean that….you’re somebody who takes pride in the details. You mean that…you waste energy at times. You mean that…you’re sensitive. You mean that…you see yourself as over-sensitive. You mean that…you wish you didn’t worry about what others think. I am loyal. You mean that….you stand by people. You mean that…you’ll stand by people when maybe you shouldn’t. You mean that…if someone makes a mistake, you’re forgiving. You mean that…you value loyalty in others. You mean that…it makes you angry when others switch allegiances.

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Exercise: Directive Reflection Read the sentence stem and write down 3 different responses to each item. Each should emphasize a different aspect of the statement. Example: It’s been fun, but something has got to give. I just can’t go on like this anymore.

1. You’ve enjoyed yourself. 2. You’re worried about what might happen. 3. It’s time for a change.

I know I could do some things differently, but if she would just back off, then the situation would be a

whole lot less tense; then these things wouldn’t happen.

1. You wish she would give you some space.

2. You’d like things to be less tense.

3. You could do some things differently.

I’ve been depressed lately. I keep trying things other than drinking to help myself feel better, but nothing

seems to work, except having a couple drinks.

1. You’ve been feeling down.

2. Drinking works in the short-term.

3. You might like if something other than drinking worked.

So, I’m not too worried, but it’s been over a year since I’ve had a syphilis test.

1. It’s been awhile.

2. You’re wondering about your syphilis status.

3. You’re a little worried.

My daughter thinks it’s her body and therefore she should be able to do what she wants with it. Hooking

up is no big deal to her. She just doesn’t get why I won’t back off.

1. You two have been arguing.

2. Her sexual behavior is a concern.

3. She doesn’t see how much you care.

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Open-Ended Questions:

How you ask a question will elicit different responses:

Did you drink alcohol this week? Yes/No, closed-question

How often and much do you drink? Provides more info “Three times last week”, but is still a closed-question. Could elicit a shoulder shrug or “I don’t know”.

What are you drinking habits like? Wording like this may be too vague or too broad.

When you decide to drink, tell me about the circumstances.

Creates movement, which can then be directed through use of reflective listening.

I wonder what it would be like if you decided to stop.

Open-ended statement, rather than question; creates

movement.